PG Module 8

तं नातिशीतैर्लघुभिः स्निग्धैः शोणितवर्धनैः |

ईषदम्लैरनम्लैर्वा भोजनैः समुपाचरेत् ||३८||[i]

The bhojana should be: –

• Na ati śītala
• Laghu
• Snigdha
• Śoṇita Vardhana
• Īṣat Amla/ Anamla

रक्तातिप्रवृत्तौ भोजनं नियमयन्नाह- क्षीरेत्यादि| यूषो मुद्गयूषः, रसो मांसरसः|

सुस्निग्धैरिति शोभनं कृत्वा घृतेन स्निग्धीकृतैः| अश्नीयादिति क्षीरादिसिक्तमोदनं भुञ्जीत|

पित्तदुष्टरक्तस्यैवातिप्रवृत्तावतिप्रवृत्तरक्तस्य क्षीरभोजनम्, अथवा पित्तप्रकृतिकस्यैव रक्तातिप्रवृत्तौ क्षीरभोजनं, कफदुष्टरक्तस्यैवातिप्रवृत्तावतिप्रवृत्तरक्तस्य यूषभोजनं, श्लेष्मप्रकृतिकस्यैव वा;

वातदुष्टरक्तस्यैवातिप्रवृत्तावतिप्रवृत्तरक्तस्य रसभोजनं, वातप्रकृतिकस्यैव वा;

अन्ये तु दीप्तमध्यमन्दाग्नीनां यथासङ्ख्यं क्षीरादिसिक्तमोदनं भोजनमाहुः; सात्म्यापेक्षयेत्येके|

[Dalhana commentry][ii]

According to Dalhana  Ācārya, first the patient is made Susnigdha i.e Snigdha by giving Ghṛta. Followed by diet as follows: –

• Pittaprakṛti and Pitta Duṣṭa Rakta Atisrava  – Kṣīra Bhojana
• Kapha Prakṛti and Kapha Dusta Rakta Atisrava – Yūṣa Bhojana
• Vāta Prakṛti and Vata Duṣṭa Rakta Atisrava – Rasa Bhojana
• Others with Dīpta, Madhya and Alpa Angni also should be given Kṣīradi Sikta Odana respectively.

मासमात्रं वा स्नेहादिभिरुपचर्य पुनर्विध्येत्|१९|[iii]

According to Vāgbhaṭa  Ācārya, the same Sneha vidhi can be followed for 1 month after raktamokṣaṇa.

तत्र स्निग्धस्विन्नवान्तविरिक्तास्थापितानुवसितसिराविद्धैः परिहर्तव्यानि- क्रोधायासमैथुनदिवास्वप्न वाग्व्यायामयानाध्ययनस्थानासनचङ्क्रमणशीतवातातपविरुद्धासात्म्याजीर्णान्याबललाभात्, मासमेके मन्यन्ते ||२४||[iv]  

According to Suśruta  Ācārya, due to bāla abhāva one should avoid:

• Krodha
• Āyasa
• Maidhuna
• Divāsvapna
• Ativāk
• Ativyayāma
• Atiyāna
• Adhyayana
• Atyāsana
• Aticaṅkramaṇa
• Ati Śīta, Ati Vāta, Ati Ātapa Seva
• Virudha, Asātmya, Ajīrṇa Bhojana.

[i]  Su. Su. 14/37-38

[ii] Dalhana – Su. Su. 14/37-38

[iii] AS. Su. 36/22

[iv] Su. Sh. 8/24

अथ पतितां तण्डुलकण्डनप्रदिग्धगात्रीं तैललवणाभ्यक्तमुखीं वामहस्ताङ्गुष्ठाङ्गुलीभ्यां गृहीतपुच्छां दक्षिणहस्ताङ्गुष्ठाङ्गुलिभ्यां शनैः शनैरनुलोममनुमार्जयेदामुखात्, वामयेत् तावद्यावत् सम्यग्वान्तलिङ्गानीति |

सम्यग्वान्ता सलिलसरके न्यस्ता भोक्तुकामा सती चरेत् |

या सीदती न चेष्टते सा दुर्वान्ता, तां पुनः सम्यग्वामयेत् |

दुर्वान्ताया व्याधिरसाध्य इन्द्रमदो नाम भवति [२३] |

अथ सुवान्तां पूर्ववत् सन्निदध्यात् ||[i]

After proper sucking the blood, the Jalaukā has to be made vomited by using Sarṣapa or Saidhava Cūrṇa or Haridra Cūrṇa. The head of the Jalaukā should be held with thumb and index finger of left hand. With the fingers of right hand, the Jalaukā is given mild rubbing from tail end to the mouth for proper vomiting. After proper vomiting the Jalaukā has to be transferred to clear water to see for activeness and search for blood or food. If the Jalaukā appears less active and lack of desire for food, it states improper vomiting. Then it should be subjected again for Samyak Vamana of blood. If the Jalaukā is not properly vomited and reused, it will lead to an Asādhya Vyādhi called Indramada.

शोणितस्य योगायोगानवेक्ष्य शतधौतघृताभ्यङ्गः, तत्पिचुधारणं वा; जलौकोव्रणान् मधुनाऽवघट्टयेत्, शीताभिरद्भिः परिषेचयेद्बध्नीत वा, कषायमधुरस्निग्धशीतैश्च प्रदेहैः प्रदिह्यादिति||[ii]

After assessment of the proper Lakṣaṇas of the Vidhi, Śatadhauta Ghṛta application or its Picu application is adviced. The Vraṇa can be smeared with Madhu or washed with Śīta Jala. Then, proper bandaging has to be done. Also, Pradeha with Kaṣāya, Madhura, Snigdha, Śīta Dravyas are also indicated.

[i] Su. Su. 13/22

[ii] Su. Su. 13/22

तत्र विषपित्तरक्तहरां क्रियां कुर्वीत|[i]

According to Ācārya Vāgbhaṭa, various measures of Viṣahara, Pittahara and Raktahara treatments can be followed in case of arousal of any complications seen after Jalauka bite.

तत्र महागदः पानालेपननस्यकर्मादिषूपयोज्यः |

इन्द्रायुधादष्टमसाध्यम् |

इत्येताः सविषाः सचिकित्सिता व्याख्याताः ||११||[ii]

Ācārya Suśruta, also advised to use Mahā Agada in the form of Pāna, Alepana and Nasādi Karmas for the management of Saviṣa Jalaukā bite. Whereas, Indramada is considered as incurable one.

Modern Medicines for Saviṣa Jalaukā bite

• Initial treatment should include removal of the leech or leeches, controlling blood loss, and preventing exposure to pathogens.
• Various methods of leech removal have been utilized including salt, saline, vinegar, alcohol, and heat etc. Chemical methods have also been used including lidocaine, and topical anaesthetic spray etc. Saltwater is also very effective in causing the leech to relax and release.
• After removing the leech, the wound must be cleaned, and bleeding must be stopped. Betadine or topical antibiotic agents like bacitracin / neomycin / polymyxin b can be used to clean the wound.
• A haemostatic agent or bandage can be used in addition to a pressure dressing to help with haemostasis. Cauterization, local application of tranexamic acid, silver nitrate, suturing of wounds, and tampon use have all be described as methods for achieving haemostasis after a leech bite. Tranexamic acid has also been used to achieve haemostasis.
• Bacteria of the genus Aeromonas reside within the gut of the leech, and reports of infection after leech therapy have been reported. Prophylactic antibiotics directed like Ciprofloxacin and trimethoprim-sulfamethoxazole are recommended after leech exposure, whether intentional or incidental.

[i] AS. Su 35/3

[ii] Su. Su. 13/11